NPIMap

Organization Active NPI

Chesapeake Wellness Center

  • Addiction Medicine (Family Medicine) Physician
  • Cecilton, MD
National Provider Identifier
1083163307
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
H0056426 Issued in MD
Legal business name
CHESAPEAKE WELLNESS CENTER
Practice address
251 S Bohemia Ave
Cecilton, MD 21913-1010
Phone
(410) 275-8156
Fax
(877) 433-6830
NPI assigned
Sep 28, 2016
Last updated
Dec 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Linda Jean Katz
Title
Sole Member
Phone
(410) 275-8156

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R177831 MD
Addiction (Substance Use Disorder) Psychologist 103TA0400X XK8322339 MD
Addiction Medicine (Family Medicine) Physician 207QA0401X H0056426 MD Primary

Addresses

Primary practice location

251 S Bohemia Ave
Cecilton, MD 21913-1010

Mailing address

79 Port Herman Rd
Chesapeake City, MD 21915-1633
Phone (410) 275-8156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170104000084 MD Part B Supplier - Clinic/Group Practice 5991086076 Receives reassigned benefits from 2 practitioners
Practice locations: Cecilton, MD; Chestertown, MD; Elkton, MD

National Provider Directory

National Provider Directory
Tax ID family
Chesapeake Wellness Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1083163307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 PORT HERMAN RD",
            "city": "CHESAPEAKE CITY",
            "state": "MD",
            "postal_code": "219151633",
            "telephone_number": "410-275-8156",
            "fax_number": "877-433-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 S BOHEMIA AVE",
            "city": "CECILTON",
            "state": "MD",
            "postal_code": "219131010",
            "telephone_number": "410-275-8156",
            "fax_number": "877-433-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-28",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "KATZ",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "410-275-8156"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R177831",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "XK8322339",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MD",
            "license": "H0056426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cecilton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.